Transcript

Norman Swan: When talking to Chris Berg just now I mentioned the abdominal symptoms that are linked to ovarian cancer. But in fact there's a fair bit of confusion around among GPs about which women with these symptoms they need to act on and those where there's no need to worry. Women are also likely to be unsure of when to be concerned. And again going back to that interview, the stakes are high because the only reliable way to diagnose ovarian cancer is to remove the ovary.

Well research from Melbourne may help. Professor Marian Pitts is Director of the Australian Research Centre in Sex, Health and Society at La Trobe University.

Marian Pitts: We've been conducting a longitudinal study of Australian men and women through telephone interviews for about 5 years and we've used the opportunity of the annual telephone interview to ask a series of questions about a range of topics, different each year. And I'd done some work on chronic pelvic pain and discussing that work with Professor Michael Quinn at the Women's Hospital there just to talk about the sort of symptoms that are indicative of ovarian cancer. And it was Michael Quinn who suggested that we might need to find out how common these symptoms were in the general population i.e. women who have not had a diagnosis of ovarian cancer. So we included those questions in the fourth wave of our study.

Norman Swan: So what questions were you asking, what symptoms were you looking for?

Marian Pitts: Well we went back through the literature and identified the symptoms that are most commonly associated with ovarian cancer. We asked about those so we asked about abdominal pain, abdominal bloating, pelvic pain itself, increased abdominal size, a feeling full quickly after eating - the range of standard symptoms that have been identified as potentially associated with ovarian cancer.

Norman Swan: And of course people have been saying for a while 'well those are common symptoms in the community how good are they at detecting women at risk of ovarian cancer'?

Marian Pitts: That's exactly right but we didn't actually know how common they were in women that had not had a diagnosis of ovarian cancer. We knew they were common in women who had received that diagnosis but we didn't know what the background prevalence was of those symptoms. And so this study provided us with the opportunity of asking those questions of the general population of women in Australia.

Norman Swan: And it was 2,000 women basically of all ages?

Marian Pitts: Yes, between the ages of 18 and 70 so a good range.

Norman Swan: And what was the average age?

Marian Pitts: The average age was late 40s.

Norman Swan: And what did they tell you?

Marian Pitts: Well they told us that the symptoms are indeed very common in the community so more than half of the women in our sample had experienced abdominal bloating in the past year, around 30% reported an increase in abdominal size and around the same percentage had reported pelvic pain and feeling full very quickly after eating or an inability to eat normally were also reported by about 1 in 6 of our women, so only a third of our women did not experience any of the six symptoms in the past year.

Norman Swan: Oh really?

Marian Pitts: Yes, that led us to look more carefully at what perhaps were the less common but more worrying aspects of the symptoms that might be a better indication of potential problems. So around a third of our women reported three or more symptoms in the past year and when we looked back at early research this combination of three or more symptoms started to make us think that this is perhaps a more important message to be getting across. And in particular we found that those symptoms that were severe and persisted over time were perhaps better indicators that there might be an underlying problem.

Norman Swan: What were the three symptoms, the collection of symptoms that seemed to congregate in a smaller percentage of women?

Norman Swan: So that helped a little bit but not a lot, I mean you had 1 in 3 women affected by this.

Marian Pitts: Yes, but if you look at those women who report the most common symptom which is abdominal bloating only 4% of the women who reported that symptom reported it as having been severe. So that tends to take us to perhaps a more targeted and tailored approach to the way in which we're communicating our health messages around ovarian cancer.

Norman Swan: And persistence was the other issue?

Marian Pitts: That's right, and it seems to me that that combination of three or more of the symptoms plus severity in one or more symptoms, plus persistence over time would be a much more targeted approach than at the moment the sort of just general 'be aware' because a lot of women in Australia are going to experience some of these symptoms some of the time. And it's very likely that if we continue with public health messages that are promoting general awareness then we're probably going to increase anxiety unnecessarily amongst many women and there may also be unnecessary GP consultations although I'm sure every practitioner would want women to err on the side of caution in that.

So I think a tailoring of a public health message along the lines of be alert not alarmed with that combination of three or more symptoms that are severe and that persist will be a more targeted and useful message for women.

Norman Swan: Did you follow these women through at all to see whether or not any of them ended up with a diagnosis?

Marian Pitts: That would be beyond the scope of our study.

Norman Swan: It's an interesting ethical issue when you survey people whether you go back to them and say 'oh, we've got some symptoms here which makes me think you need to get checked by your GP'.

Marian Pitts: It is an ethical issue but I think particularly in this case the very finding that the symptoms are as common as they are means that there would be no way that we would be able to come up with anything that it was even remotely a potential diagnosis of ovarian cancer. Hopefully these women, like all women in Australia, would be subject to the public health messages that are around there at the moment.

Norman Swan: And of course the next step in this kind of research is to see whether those three symptoms plus severity plus persistence does more accurately predict ovarian cancer risk. Professor Marian Pitts is Director of the Australian Research Centre in Sex Health and Society at La Trobe University.

Reference:

Pitts MK et al. High prevalence of symptoms associated with ovarian canc er among Australian women. Australian and New Zealand Journal of Obstetrics and Gynaecology 2011;51:71-78

Guests

Professor Marian Pitts

Director,Australian Research Centre in Sex, Health and Society,La Trobe University,Melbourne